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Seoud M, Chahine R, Arab W, Jaafar I, Moubarak M, El Kassis N, Abdallah R, Ramadan MK, Nassar M, Nassar A, Ayoub EN, Atallah D. The Lebanese percreta group: A retrospective cohort study of both radical and conservative management outcomes of abnormally invasive placenta. Int J Gynaecol Obstet 2024. [PMID: 38798144 DOI: 10.1002/ijgo.15701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 05/07/2024] [Accepted: 05/11/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE The aim of the present study was to illustrate the outcomes of abnormally invasive placenta (AIP) cases managed in three leading centers in Lebanon. METHODS We conducted a retrospective multicenter cohort study. Patients managed conservatively (cesarean delivery with successful placental separation) or radically (cesarean hysterectomy) were included in the study. Data included patient characteristics, surgical outcomes (blood loss, operative time, transfusion, partial bladder resection), maternal outcomes (death, length of stay, ICU admission, postoperative hemoglobin level) and neonatal outcomes (Apgar score, neonatal weight, admission to neonatal intensive care unit, neonatal death). RESULTS The study included 189 patients. In the radical treatment subgroup (141/189), patients were para 3 and delivered at 34 4/7 weeks in average, bled 1.5 L and were transfused with three packed red blood cells, with operative time averaging 160 min. A total of 36% were admitted to the ICU and patients stayed on average for 1 week despite partial bladder resection in 19% of cases. Unscheduled radical delivery occurred at a lower gestational age, was associated with more blood loss, higher rate and volume of transfusion, and risk of maternal and neonatal death. In addition, patients delivered in an unscheduled fashion experienced higher rates of partial bladder resection and longer interventions. In the conservative treatment subgroup, on average patients were para 2 and delivered at 36 weeks, bled 800 mL on average with low rates of transfusion (35%) and ICU admission (22.9%). With regard to neonatal outcomes, the average neonatal birth weight was 2.4 kg in the radical subgroup and 2.5 kg in the conservative subgroup. Neonatal death occurred in 5.4% of cases requiring radical management while it occurred in 2% of patients treated conservatively. CONCLUSION Through their multidisciplinary approach, the three centers demonstrated that management of AIP in Lebanon has led to excellent outcomes with no maternal mortality occurring in scheduled radical treatment. By comparison of the three leading centers, pitfalls in each center were identified and addressed.
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Affiliation(s)
- Muhieddine Seoud
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Rabih Chahine
- Department of Obstetrics and Gynecology, Rafic Hariri University Hospital (RHUH), Beirut, Lebanon
| | - Wissam Arab
- Department of Obstetrics and Gynecology, Hotel-Dieu de France (HDF) University Hospital, Saint-Joseph University, Beirut, Lebanon
| | - Iman Jaafar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Malak Moubarak
- Department of Obstetrics and Gynecology, Hotel-Dieu de France (HDF) University Hospital, Saint-Joseph University, Beirut, Lebanon
| | - Nadine El Kassis
- Department of Obstetrics and Gynecology, Hotel-Dieu de France (HDF) University Hospital, Saint-Joseph University, Beirut, Lebanon
| | - Reem Abdallah
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Mohamad K Ramadan
- Department of Obstetrics and Gynecology, Rafic Hariri University Hospital (RHUH), Beirut, Lebanon
| | - Malek Nassar
- Department of Obstetrics and Gynecology, Hotel-Dieu de France (HDF) University Hospital, Saint-Joseph University, Beirut, Lebanon
| | - Anwar Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Eliane Nasser Ayoub
- Intensive Care and Anesthesiology Department, Hotel-Dieu de France (HDF) University Hospital, Saint-Joseph University, Beirut, Lebanon
| | - David Atallah
- Department of Obstetrics and Gynecology, Hotel-Dieu de France (HDF) University Hospital, Saint-Joseph University, Beirut, Lebanon
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Sugai S, Yamawaki K, Sekizuka T, Haino K, Yoshihara K, Nishijima K. Comparison of maternal outcomes and clinical characteristics of prenatally vs nonprenatally diagnosed placenta accreta spectrum: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2023; 5:101197. [PMID: 37865220 DOI: 10.1016/j.ajogmf.2023.101197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/14/2023] [Accepted: 10/16/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE This study aimed to compare maternal outcomes of prenatally and nonprenatally diagnosed placenta accreta spectrum. DATA SOURCES A systematic literature search was performed in PubMed, the Cochrane database, and Web of Science until November 28, 2022. STUDY ELIGIBILITY CRITERIA Studies comparing the clinical presentation of prenatally and nonprenatally diagnosed placenta accreta spectrum were included. The primary outcomes were emergent cesarean delivery, hysterectomy, blood loss volume, number of transfused blood product units, urological injury, coagulopathy, reoperation, intensive care unit admission, and maternal death. In addition, the pooled mean values for blood loss volume and the number of transfused blood product units were calculated. The secondary outcomes included maternal age, gestational age at birth, nulliparity, previous cesarean delivery, previous uterine procedure, assisted reproductive technology, placenta increta and percreta, and placenta previa. METHODS Study screening was performed after duplicates were identified and removed. The quality of each study and the publication bias were assessed. Forest plots and I2 statistics were calculated for each study outcome for each group. The main analysis was a random-effects analysis. RESULTS Overall, 415 abstracts and 157 full-text studies were evaluated. Moreover, 31 studies were analyzed. Prenatally diagnosed placenta accreta spectrum was associated with a significantly lower rate of emergency cesarean delivery (odds ratio, 0.37; 95% confidence interval, 0.21-0.67), higher hysterectomy rate (odds ratio, 1.98; 95% confidence interval, 1.02-3.83), lower blood loss volume (mean difference, -0.65; 95% confidence interval, -1.17 to -0.13), and lower number of transfused red blood cell units (mean difference, -1.96; 95% confidence interval, -3.25 to -0.68) compared with nonprenatally diagnosed placenta accreta spectrum. The pooled mean values for blood loss volume and the number of transfused blood product units tended to be lower in the prenatally diagnosed placenta accreta spectrum groups than in the nonprenatally diagnosed placenta accreta spectrum groups. Nulliparity (odds ratio, 0.14; 95% confidence interval, 0.10-0.20), previous cesarean delivery (odds ratio, 6.81; 95% confidence interval, 4.12-11.25), assisted reproductive technology (odds ratio, 0.19; 95% confidence interval, 0.06-0.61), placenta increta and percreta (odds ratio, 3.97; 95% confidence interval, 2.24-7.03), and placenta previa (odds ratio, 6.81; 95% confidence interval, 4.12-11.25) showed statistical significance. No significant difference was found for the other outcomes. CONCLUSION Despite its severity, the positive effect of prenatally diagnosed placenta accreta spectrum on outcomes underscores the necessity of a prenatal diagnosis. In addition, the pooled mean values provide a preoperative preparation guideline.
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Affiliation(s)
- Shunya Sugai
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan.
| | - Kaoru Yamawaki
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Tomoyuki Sekizuka
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Kazufumi Haino
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Kosuke Yoshihara
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Koji Nishijima
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan.
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Donati S, Buoncristiano M, D’Aloja P, Maraschini A, Corsi Decenti E, Lega I. Uptake and Adherence to National Guidelines on Postpartum Haemorrhage in Italy: The MOVIE before-after Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5297. [PMID: 37047913 PMCID: PMC10093811 DOI: 10.3390/ijerph20075297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 06/19/2023]
Abstract
Translating evidence-based guidelines into clinical practice is a complex challenge. This observational study aimed to assess the adherence to the Italian national guidelines on postpartum haemorrhage (PPH) and describe the clinical management of haemorrhagic events in a selection of maternity units (MUs) in six Italian regions, between January 2019 and October 2020. A twofold study design was adopted: (i) a before-after observational study was used to assess the adherence to national clinical and organisational key recommendations on PPH management, and (ii) a cross-sectional study enrolling prospectively 1100 women with PPH ≥ 1000 mL was used to verify the results of the before-after study. The post-test detected an improved adherence to 16/17 key recommendations of the guidelines, with clinical governance and communication with family members emerging as critical areas. Overall, PPH management emerged as appropriate except for three recommended procedures that emphasise different results between the practices adopted and the difference between what is considered acquired and what is actually practised in daily care. The methodology adopted by the MOVIE project and the adopted training materials and tools have proved effective in improving adherence to the recommended procedures for appropriate PPH management and could be adopted in similar care settings in order to move evidence into practice.
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Affiliation(s)
- Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
| | - Marta Buoncristiano
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
| | - Paola D’Aloja
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
| | - Alice Maraschini
- Servizio Tecnico Scientifico di Statistica-Italian National Institute of Health, 00161 Rome, Italy;
| | - Edoardo Corsi Decenti
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
| | - Ilaria Lega
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
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Wekere FCC, Inimgba NM, Kua PL, Okagua KE, Asikimabo-Ofori S, Ocheche US, Clement-Wekere GAF. Placenta Accreta Spectrum: Prevalence, Trend and Association with Sociodemographic / Obstetric Factors in a Tertiary Health Facility in Niger Delta, Nigeria. Niger Med J 2022; 63:467-473. [PMID: 38884036 PMCID: PMC11170246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024] Open
Abstract
Background Placenta accreta spectrum (PAS) describes the abnormal adherence of the placenta trophoblast to the myometrium and is associated with high foeto-maternal morbidity and mortality. This study was aimed at determining the prevalence, and trend of placenta accreta spectrum (PAS), as well as its association with sociodemographic/obstetrics factors at the Rivers State University Teaching Hospital (RSUTH). Methodology An analytical cross-sectional study of all recorded cases of placenta accreta spectrum managed at RSUTH from 1st January 2016 to 31st December 2021. Descriptive and inferential statistics were derived using IBM, Statistical Product and Service Solution (SPSS) version 25.0 Armonk, NY. Results There were 14195 deliveries, 137 cases of placenta praevia and 39 cases of placenta accreta spectrum. The prevalence of PAS at the RSUTH was 0.27% or 2.7 /1000 deliveries or 1in 370 deliveries. The rate of PAS among cases of placenta praevia was 28.5% or 1 in 4 cases. More than half of the variants of PAS were accreta 23 (59.0%) while 13(33.3%) and 3(7.7%) were increta and percreta respectively. The mean (SD) age and gestational age of the participants were 32.28 (± 5.13), [95% Confidence Interval (CI): 30.63, 33.92] and 36.43(±2.01), (95%CI: 35.18, 37.07) respectively. The modal age group was 35-39 years. The median blood loss was 650mls range of 450-2000mls. The majority of the study participants were booked 34(87.2%) and had secondary level education 17(43.6%). History of a previous caesarean section was statistically significantly associated with PAS P<0.001 while other factors did not attain significance. Conclusion Placenta accreta spectrum is not uncommon among women with pregnancies complicated by placenta praevia at the RSUTH. PAS occurred more among booked multiparous women with secondary level education and with an increasing trend. History of previous caesarean section is strongly associated with PAS.
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Affiliation(s)
- Felix Chikaike Clement Wekere
- Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Port Harcourt, Rivers State, Nigeria
- Department of Community Medicine, College of Medical Sciences, Rivers State University, Port Harcourt, Nigeria
| | - Nestor M Inimgba
- Department of Obstetrics and Gynaecology, PAMO University of Medical Sciences, Port Harcourt, Nigeria
| | - Paul L Kua
- Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - Kenneth E Okagua
- Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - Sotonye Asikimabo-Ofori
- Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - Uduak S Ocheche
- Department of Obstetrics and Gynaecology, PAMO University of Medical Sciences, Port Harcourt, Nigeria
| | - Gift A F Clement-Wekere
- Department of Paediatrics and Child Health, University of Port Harcourt Teaching Hospital, Rivers State, Nigeria
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Ming Y, Zeng X, Zheng T, Luo Q, Zhang J, Zhang L. Epidemiology of placenta accreta spectrum disorders in Chinese pregnant women: A multicenter hospital-based study. Placenta 2022; 126:133-139. [DOI: 10.1016/j.placenta.2022.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/26/2022] [Accepted: 06/20/2022] [Indexed: 01/10/2023]
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Placenta Accreta Spectrum Disorder Complicated with Endometriosis: Systematic Review and Meta-Analysis. Biomedicines 2022; 10:biomedicines10020390. [PMID: 35203599 PMCID: PMC8962380 DOI: 10.3390/biomedicines10020390] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/24/2022] [Accepted: 02/03/2022] [Indexed: 02/06/2023] Open
Abstract
This study aimed to assess the relationship between placenta accreta spectrum disorder (PASD) and endometriosis. The relationships among pregnancy, assisted reproductive technology (ART), placenta previa, ART-conceived pregnancy and PASD were also determined. A systematic literature review was conducted using multiple computerized databases. Forty-eight studies (1990–2021) met the inclusion criteria. According to the adjusted pooled analysis (n = 3), endometriosis was associated with an increased prevalence of PASD (adjusted odds ratio [OR] 3.39, 95% confidence interval [CI] 1.96–5.87). In the included studies, the ART rate ranged from 18.2% to 37.2% for women with endometriosis. According to the adjusted pooled analysis, women who used ART were more likely to have placenta previa (n = 13: adjusted OR 2.96, 95%CI, 2.43–3.60) and PASD (n = 4: adjusted OR 3.54, 95%CI 1.86–6.76) than those who did not use ART. According to the sensitivity analysis using an unadjusted analysis accounting for the type of ART, frozen embryo transfer (ET) was associated with an increased risk of PASD (n = 4: OR 2.79, 95%CI, 1.22−6.37) compared to fresh ET. Endometriosis may be associated with an increased rate of PASD. Women with placenta previa complicated with endometriosis who conceived using frozen ET may be a high risk for PASD.
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Uebergang J, Hiscock R, Hastie R, Middleton A, Pritchard N, Walker S, Tong S, Lindquist A. Risk of obstetric anal sphincter injury among women who birth vaginally after a prior caesarean section: A state-wide cohort study. BJOG 2021; 129:1325-1332. [PMID: 34913246 DOI: 10.1111/1471-0528.17063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/30/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Vaginal birth after caesarean (VBAC) has been suggested to be associated with an increased risk of obstetric anal sphincter injury (compared with primiparous women who birth vaginally). However, prior studies have been small, or used outdated methodology. We set out to validate whether the risk of obstetric anal sphincter injury among women having their first VBAC is greater than that among primiparous women having a vaginal birth. DESIGN State-wide retrospective cohort study. SETTING Victoria, Australia. POPULATION All births (455,000) between 2009-2014. METHODS The risk of severe perineal injury between first vaginal birth and first vaginal birth after previous caesarean section was compared, after adjustment for potential confounding variables. Covariates were examined using logistic regression for categorical data and Wilcoxon rank-sum test for continuous data. Missing data were handled using multiple imputation; the analysis was performed using regression adjustment and Stata v16 multiple imputation and teffects suites. RESULTS Women having a VBAC (n=5,429) were significantly more likely than primiparous women (n=123,353) to sustain a 3rd or 4th degree tear during vaginal birth (7.1 vs 5.7%, p<0.001). After adjustment for mode of birth, body mass index, maternal age, infant birthweight, episiotomy and epidural, there was a 21% increased risk of severe perineal injury (relative risk 1.21 (95%CI 1.07 - 1.38)). CONCLUSIONS Women having their first vaginal birth after caesarean section have a significant increased risk of sustaining a 3rd or 4th degree tear, compared with primiparous women having a vaginal birth. Patient counselling and professional guidelines should reflect this increased risk.
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Affiliation(s)
| | - Richard Hiscock
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia.,Department of Anaesthesia, Mercy Hospital for Women, Melbourne, Australia
| | - Roxanne Hastie
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia.,Mercy Perinatal, Mercy Hospital for Women, Melbourne, Australia
| | - Anna Middleton
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Natasha Pritchard
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia.,Mercy Perinatal, Mercy Hospital for Women, Melbourne, Australia
| | - Susan Walker
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia.,Mercy Perinatal, Mercy Hospital for Women, Melbourne, Australia
| | - Stephen Tong
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia.,Mercy Perinatal, Mercy Hospital for Women, Melbourne, Australia
| | - Anthea Lindquist
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia.,Mercy Perinatal, Mercy Hospital for Women, Melbourne, Australia
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Donati S, Corsi E, Maraschini A, Salvatore MA. SARS-CoV-2 infection among hospitalised pregnant women and impact of different viral strains on COVID-19 severity in Italy: a national prospective population-based cohort study. BJOG 2021; 129:221-231. [PMID: 34687585 PMCID: PMC8652503 DOI: 10.1111/1471-0528.16980] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/20/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The primary aim of this article was to describe SARS-CoV-2 infection among pregnant women during the wild-type and Alpha-variant periods in Italy. The secondary aim was to compare the impact of the virus variants on the severity of maternal and perinatal outcomes. DESIGN National population-based prospective cohort study. SETTING A total of 315 Italian maternity hospitals. SAMPLE A cohort of 3306 women with SARS-CoV-2 infection confirmed within 7 days of hospital admission. METHODS Cases were prospectively reported by trained clinicians for each participating maternity unit. Data were described by univariate and multivariate analyses. MAIN OUTCOME MEASURES COVID-19 pneumonia, ventilatory support, intensive care unit (ICU) admission, mode of delivery, preterm birth, stillbirth, and maternal and neonatal mortality. RESULTS We found that 64.3% of the cohort was asymptomatic, 12.8% developed COVID-19 pneumonia and 3.3% required ventilatory support and/or ICU admission. Maternal age of 30-34 years (OR 1.43, 95% CI 1.09-1.87) and ≥35 years (OR 1.62, 95% CI 1.23-2.13), citizenship of countries with high migration pressure (OR 1.75, 95% CI 1.36-2.25), previous comorbidities (OR 1.49, 95% CI 1.13-1.98) and obesity (OR 1.72, 95% CI 1.29-2.27) were all associated with a higher occurrence of pneumonia. The preterm birth rate was 11.1%. In comparison with the pre-pandemic period, stillbirths and maternal and neonatal deaths remained stable. The need for ventilatory support and/or ICU admission among women with pneumonia increased during the Alpha-variant period compared with the wild-type period (OR 3.24, 95% CI 1.99-5.28). CONCLUSIONS Our results are consistent with a low risk of severe COVID-19 disease among pregnant women and with rare adverse perinatal outcomes. During the Alpha-variant period there was a significant increase of severe COVID-19 illness. Further research is needed to describe the impact of different SARS-CoV-2 viral strains on maternal and perinatal outcomes.
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Affiliation(s)
- S Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - E Corsi
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy.,Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - A Maraschini
- Servizio tecnico scientifico di statistica, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - M A Salvatore
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
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Zhong W, Zhu F, Li S, Chen J, He F, Xin J, Yang M. Maternal and Neonatal Outcomes After Planned or Emergency Delivery for Placenta Accreta Spectrum: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:731412. [PMID: 34650996 PMCID: PMC8505704 DOI: 10.3389/fmed.2021.731412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: To compare maternal and neonatal outcomes for women with placenta accreta syndrome (PAS) delivering via a planned or emergent approach. Methods: A systematic search for relevant studies was conducted by screening the PubMed, Scopus, Web of Science, and Google Scholar electronic databases. Included studies should have been retrospective record-based or prospective in design. They must have compared maternal and/or neonatal outcomes for PAS patients delivering via planned and emergency procedures. Strength of association was presented as pooled adjusted relative risk (RR) for categorical outcomes and weighted mean difference (WMD) for continuous outcomes. Statistical analysis was done using STATA version 16.0. Results: Nine articles were included in the meta-analysis. PAS patients undergoing planned deliveries had increased gestational ages, required fewer units of transfused blood, experienced shorter hospital stay durations, and presented reduced risks for maternal ICU admission and severe maternal morbidity. Neonates born to mothers undergoing planned deliveries had increased birth weights and decreased NICU admission risk. Conclusion: These findings indicate a planned approach for delivery is better for maternal and neonatal outcomes compared to urgent/emergency delivery for PAS patients.
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Affiliation(s)
- Wei Zhong
- Department of Obstetrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fang Zhu
- Department of Pain, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shengqiong Li
- Department of Obstetrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jin Chen
- Department of Obstetrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fengya He
- Department of Obstetrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jie Xin
- Department of Obstetrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Mei Yang
- Department of Traditional Therapy, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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